What are "reparative" or "conversion" therapies?

Reparative or conversion therapies claim, through the use of psychotherapy or other interventions, to eliminate a person’s sexual desire for a member of his or her own gender. The National Association of Social Workers’ National Committee on Lesbian, Gay, and Bisexual Issues (NCLGB) recognizes the emergence of these misleading therapies. Reparative and conversion therapies, sometimes called "transformational ministries," have received wider attention against the backdrop of a growing conservative religious political climate (NASW, 1992), and through recent media campaigns supported by the Christian Coalition and the Family Research Council. By advancing their efforts through such propaganda, proponents of reparative and conversion therapies, such as the most commonly cited group NARTH, claim that their processes are supported by scientific data; however, such scientific support is replete with confounded research methodologies (Mills, 1999).

What are sexual orientation, sexual identity, and sexual behavior?

Sexual orientation is defined by the sex of individuals for whom one feels an attraction and affection, both physical and emotional. Sexual orientation includes "sexual activity with members of one’s own sex (homosexual orientation), the opposite sex (heterosexual orientation), or both (bisexual orientation)" (Barker, 1999, pp. 439–440). Moreover, sexual orientation differs from other mistakenly ascribed concepts, such as sexual identity and sexual behavior. Sexual identity refers to a person’s self-perception of his or her sexual orientation, and sexual behavior refers to a person’s sexual activities. In an effort to understand human relationships and human sexuality, "social workers must be knowledgeable about biological factors, as well as about the roles played by psychological, cultural, and social factors in sexual expressions" (Harrison, 1995, p. 1419).

Can therapy change sexual orientation?

People seek mental health services for many reasons. Accordingly, it is fair to assert that lesbians and gay men seek therapy for the same reasons that heterosexual people do. However, the increase in media campaigns, often coupled with coercive messages from family and community members, has created an environment in which lesbians and gay men often are pressured to seek reparative or conversion therapies, which cannot and will not change sexual orientation. Aligned with the American Psychological Association’s (1997) position, NCLGB believes that such treatment potentially can lead to severe emotional damage. Specifically, transformational ministries are fueled by stigmatization of lesbians and gay men, which in turn produces the social climate that pressures some people to seek change in sexual orientation (Haldeman, 1994). No data demonstrate that reparative or conversion therapies are effective, and in fact they may be harmful (Davison, 1991; Haldeman, 1994).

Why is this issue relevant to the social work profession?

Social workers should have a broad-based knowledge about human sexuality, human sexual development across the life cycle, a high degree of comfort and skill in communicating and responding to such issues, and a knowledge of appropriate community services (Harrison, 1995). Social workers across fields of practice, including foster care, mental health, corrections, substance abuse, school social work, and prevention education, may encounter lesbian and gay clients. The literature indicates that "interventative therapies" that attempt to alter sexual orientation of lesbians and gay men have succeeded only in reducing sexual behavior and self-esteem rather than shaping attractions of opposite gender (Haldman, 1994).

What are the value and ethical implications for social workers?

NCLGB asserts that conversion and reparative therapies are an infringement to the guiding principles inherent to social worker ethics and values. This belief is affirmed by the NASW policy statement on "Lesbian, Gay, and Bisexual Issues" (1996). In discussing ethical decisions for social work practice, Loewenberg and Dolgoff (1996) noted, "the priority of professional intervention at the individual level will be to help people achieve self-actualization, rather than helping them to learn how to adjust to the existing social order" (p. 47). The NASW Code of Ethics enunciates principles that address ethical decision making in social work practice with lesbians, gay men, and bisexual people—for example, social workers’ commitment to clients’ self-determination and competence, to achieving cultural competence and understanding social diversity, and to clients who lack decision-making capacity; social workers’ ethical responsibilities to colleagues, their commitment to interdisciplinary collaboration, and their responsibility to report unethical conduct of colleagues; social workers’ ethical responsibilities as professionals—maintaining competence, fighting discrimination, and avoiding misrepresentation; social workers’ ethical responsibilities to the social work profession, to evaluation, and to research.

How can I practice the nondiscrimination tenets of my profession?

A social worker may apply techniques that may cause considerable harm and anguish for a client while reinforcing the existing prejudice and homophobia that gay men and lesbians experience daily. The use of these therapies deny the viability of same-gender relationships as fulfilling and natural; many lesbians and gay men in such arrangements report significant satisfaction and contentment. Social workers need to be aware of the scripted attitudes toward lesbians and gay men (NASW, 1992). As first asserted in the original NCGLB reparative therapy position statement (1992), "If a client is uncomfortable about his/her sexual orientation, the sources of discomfort must be explored, but without prior assumption that same-sex attraction is dysfunctional" (pp. 1, 2). Social workers are obligated to use nonjudgmental attitudes and to encourage nurturing practice environments for lesbians, gay men, and bisexuals. NASW discourages social workers from providing treatments designed to change sexual orientation or from referring clients to practitioners or programs that claim to do so (NASW, 1992).

What can social workers do?

NASW’s policy statement on lesbian, gay, and bisexual issues can be viewed as a "blueprint" for social work’s role in addressing the concerns and strengths of gay, lesbian, and bisexual clients and communities both within and outside the profession. The policy states, "NASW supports legislation, regulation, policies, judicial review, political action, and changes in social work policy statements and the NASW Code of Ethics (1996), and any other means necessary to establish and protect the equal rights of all people without regard to sexual orientation" (p. 202).

References

American Psychological Association. (1997). Resolution: Reparative therapy. Washington, DC: Author.Barker, R. L. (1999). The social work dictionary (4th ed.). Washington, DC: NASW Press.Davison, G. C. (1991). Construction and morality in therapy for homosexuality. In J. C. Gonsiorek & J. D. Weinrich (Eds.), With compassion toward some: Homosexuality and social work in America (pp. 115–136). New York: Harrington Press.Haldeman, D. C. (1994). The practice and ethics of sexual orientation conversion therapy. Journal of Consulting and Clinical Psychology, 62, 211–221.Harrison, D. F. (1995). Human sexuality. In R. L. Edwards (Ed.-in-Chief), Encyclopedia of social work (19th ed., Vol. 2, pp. 1418–1428). Washington, DC: NASW Press.Loewenberg, F. M., & Dolgoff, R. (1996). Ethical decisions for social work practice. Itasca, IL: F. E. Peacock.Mills, K. I. (1999). Mission impossible: Why reparative therapy and ex-gay ministries fail (2nd ed.) [Brochure]. Washington, DC: Human Rights Campaign.National Association of Social Workers. (1996). Code of ethics. Washington, DC: Author.National Association of Social Workers. (1996). Lesbian, gay, and bisexual issues. In Social work speaks (4th ed., pp. 198–209). Washington, DC: NASW Press.National Association of Social Workers, National Committee on Lesbian and Gay Issues. (1992). Position statement: Reparative or conversion therapies for lesbians and gay men. Washington, DC: Author.